A qualitative evaluation of Veterans Health Administration’s implementation of measurement-based care in behavioral health.

Abstract

Measurement-based care (MBC) in behavioral health involves the repeated collection of patientreported data that is used to track progress, inform care, and engage patients in shared decision making about their treatment. Research suggests that MBC increases the quality and effectiveness of mental health care. However, there can be challenges to implementing MBC, such as time burden, lack of resources to support MBC, and clinician attitudes. The Veterans Health Administration (VHA) is currently undertaking a multiphase MBC roll-out, the first phase of which included 59 sites across the country. The present study examined implementation of this initiative in an effort to learn more about the process of implementation, including best practices, challenges, and innovations. Semistructured interviews were conducted with 20 MBC site champions and 60 staff members from 25 VHA medical centers across the country. Qualitative data analysis was conducted to identify key themes related to MBC implementation. Results were described for 3 components of MBC implementation: preparing for implementation, administering measures, and using and sharing data. Training and staff buy-in were key to the preparation phase. Staff members reported a variety of methods and frequencies for the collection of MBC data, with many staff members identifying a need to streamline the collection process. Staff members reported using data to track progress and adjust treatment with patients. Efforts to use data on a programmatic level were identified as a next step. Innovative solutions across clinics and sites are described in an effort to inform future MBC implementation, both within and outside of VHA.

Factors affecting the implementation of an outcome measurement feedback system in youth mental health settings

“…The practical implications of the current study inform supervisors and organisations of the areas of importance in supporting clinicians to use each MFS process. Workload resources and IT supports can help initiate the use of MFS (Brooks Holliday et al, 2020). These supports may reduce the barriers for clinicians with more years of clinical experience to look at measures before session.…”

Measurement-based care and psychological assessment: Using measurement to enhance psychological treatment.

“…Brooks Holliday and colleagues (2020) provide an in-depth qualitative assessment of this same VA initiative. In their study, they interviewed 20 MBC site champions and 60 individuals from 25 medical centers who were involved in early rollout efforts.…”

Data collection and outcome measurement in student counseling services in Irish higher education institutions: Counselors’ views on challenges and facilitators.

“…Our findings revealed that 50% of SCSs, who did not use an outcome measure for routine evaluation, also did not have access to an EDMS. Consistent DATA COLLECTION AND OUTCOME MEASUREMENT with Brooks Holliday et al (2020), Lewis et al (2019), andMiller et al (2005), this finding demonstrates the importance of supporting SCSs to avail of a user-friendly data management system that provides valid and reliable evaluation of therapy outcomes, is aligned with nonmedical approaches to therapy, and serves the specific needs of the SCSs and student populations. One example of such EDMS is the Partners for Change Outcome Management System (Miller et al, 2005) which is proposed as a transparent system with brief measures, a strong focus on therapeutic alliance and an alternative paradigm to medical models (Duncan et al, 2018).…”